Greene, Sarah NEW Yt )RK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
l This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District
(Town Village, or City) in which th4 i death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CER-
TIFICATE OF DEATH, LEGIBLY N VRITTEN IN DURABLE BLACK INK.
Town, Viiila
Registered No 1
Dist. No: 1'` ')' County Sar toffs or City 7 n e rf So"th ql ens Fall s
(If city, give street address)
SArah Estella Greene
Name of deceased Veteran
(If veteran, give name of War)
Sin le married, widowed,
sin le 1 7
Sex or di=vorced (write the word) Date of De .then � l 19 7
Age or Years. I Months Da s. Birthplace
Causeof'Death rferiosc ,lerrtic Heart Disease
Certificate was signed byAle xander Avrin
g _ t5:e'Y'tan AVe , M.D.
Address x Glens Fa1Jss,N.Y. 1 Z801
Place of Burial (or Removal) burial
(If body is to be temporarily d, fill in gpac o later)
Cemetery Zn¢ v7 eT{' (i- e ";.t Date of Burial 1 /8 19 77
(If body is to be temporarily held, fill in spacrif.►ater)
The Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
nation,,the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accepted the same for ri•egistration, have recorded it in my Local Record with the above stated Registered
Number, nd n the basis theretof I HEREBY GRANT A PERMIT
to J . Greio. 6ulliv s,1 67 Park St., Glens Falls,N.Y.12801
±AttMX ungl )taker inter (Address)
the to hold temporarily an,. the body
(Undertaker or perso having char a of co se) . move,or cith wt a of [state how])
�anuar;r 7 7le�
Dated 19 (Signed).. /a/ !!
Local Registrar
This Permit is sufficient for tht'Removal (and Interment or Cremation) of a body to any part of the State (subject to local.
cemetery or other regulations), unlessremoval is by common carrier, in which case a Transit Permit (VS No, 62) is required.
Form VS. 61, (Rev, 6/63) (3A2-323)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS qR
CREMATIONS ARE MADE
r
Date of �� was �WL . 19
(Interment or•
(Name of Cemetery, Cre lw.)._..,,,,,,,,. _.,...
Section Lot No. " Grave
(Signed
(Person in Charge),
Address ���'
��-7 / a oee2,
Person in charge must return this Permit to the Registrar
of his District within SEVEN (7) DAYS from above date. If no
person is in charge, the FUNERAL DIRECTOR or UNDER-
TAKER MUST SIGN ABOVE STATEMENT, write across the
face of the Permit the words "No person in charge," and FILE
PERMIT WITHIN THREE (3) DAYS "vr.ia the Registrar of Dis-
trict in which cemetery is located.
SEXTONS,FUNERAL DIRECTORS and UNDERTAKERS
violating the law relative to the return of permits are liable to
a penalty of NOT LESS THAN FIVE DOLLARS NOR MORE
THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The law
will be enforced. Local Registrars are required, under penalty,
to report violations thereof.